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© Research
Publication : Clinical Microbiology and Infection

High Acquisition Rate of ESBL-Producing Enterobacteriaceae among French Military Personnel on Mission Abroad, without Evidence of Inter-Individual Transmission.

Scientific Fields
Diseases
Organisms
Applications
Technique

Published in Clinical Microbiology and Infection - 20 Aug 2018

Maataoui, Naouale; Mayet, Aurélie; Duron, Sandrine; Delacour, Hervé; Mentré, France; Laouenan, Cédric; Desvillechabrol, Dimitri; Cokelaer, Thomas; Meynard, Jean Baptiste; Ducher, Annie

Link to Pubmed [PMID] – 30099136

Maataoui et al, Clinical Microbiology and Infection, 2018

Objectives

Acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) by Europeans traveling individually in high-endemicity countries is common. However, how the different ESBL-E strains circulate in groups of travelers has not been studied. We investigated ESBL-E transmission within several groups of French military personnel serving overseas for 4-6 months.

Methods

We conducted a prospective study among French military personnel assigned to Afghanistan, French Guiana, or Côte d’Ivoire for 4 to 6 months. Fecal samples provided by volunteers before leaving and after returning were screened for ESBL-E Escherichia coli isolates. ESBL-E. coli from each military group was characterized by repetitive element palindromic polymerase chain reaction (rep-PCR) fingerprinting followed, in the Afghanistan group, by whole-genome sequencing (WGS) if similarity was ≥97%.

Results

Among the 189 volunteers whose samples were negative before departure, 72 (38%) were positive after return. The highest acquisition rates were observed in the Afghanistan (29/33, 88%) and Côte d’Ivoire (39/80, 49%) groups. Acquisition rates on return from French Guiana were much lower (4/76, 5%). WGS of the 20 strains from the Afghanistan group that clustered by rep-PCR identified differences in sequence type, serotype, resistance genes, and plasmid replicons. Moreover, single-nucleotide polymorphism (SNP) differences across acquired strains from a given cluster ranged from 30 to 3641, suggesting absence of direct transmission.

Conclusions

ESBL-E. coli acquisition was common among military personnel posted overseas. Many strains clustered by rep-PCR but differed by WGS and SNP analysis, suggesting acquisition from common external sources rather than direct person-to-person transmission.

https://doi.org/10.1016/j.cmi.2018.07.030